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Live in Surrey or Langley and Expecting a Baby Soon? Thinking about having Doula Support for your Birth?

Prenatal Journey currently has space for one more client due Jan 2017, and one more due Feb 2017. If you’re due in March or later, there is still space. I provide Birth Doula Support to moms-to-be in Surrey, Langley, Delta, Vancouver and Abbotsford.

Having a doula is a great idea if you would like to have more support through your pregnancy, birth and postpartum time. It’s especially helpful if you want to have your best chance at having a natural birth. Doulas provide non-medical physical, emotional and informational support so that moms can have an easier time in labour and have an empowering, positive birth experience. Evidence proves that having a Doula reduces the need for pain meds like epidurals or narcotics, and also reduces the need for inductions and cesareans. They also increase successful breastfeeding rates, reduce postpartum depression, and make sure moms and babies start their new phase of life feeling supported, positive and capable.

At births, I often help moms cope with labour with specific techniques and tools – counterpressure, hip squeezes, massage, position changes, TENS machine, encouragement and so on. I also am a great listener, supporting moms through any emotional challenges they are dealing with in pregnancy, birth, or after their babies are born. Being there with moms right in labour and being available 24 hours a day by phone in pregnancy and postpartum to answer any questions, helps moms get the information they need to power them to make informed decisions about their well-being. Dads also LOVE having a doula to help out in labour. Dads are so important at births, and I always make sure I show dads how to effectively support their partners. Dads and doulas usually work as a team. Moms can’t have too much support in labour.

Prenatal Classes, and Birth Photography

Besides doula support, I also teach prenatal classes and provide birth photography. I offer private prenatal classes in Surrey, Langley, and surrounding areas. They are on your schedule and in the comfort of your own home. Group prenatal classes are in small groups and consist of two full Saturdays, or once a week for 8 weeks. Many clients also love having birth photography done to capture special memories of their child’s brith and the first moments of life.

If you’d like to register, call 604 809 3288 or email kaurina@prenataljourney.ca

Here’s what a doula and prenatal class client has said,

I was determined to give my daughter Valentina a natural birth at home without the use of any pain medication. Thanks to Kaurina, I was able to physically, emotionally and mentally prepare myself to make this happen. Kaurina was very thorough and motivating during those important months of preparation, helping my husband and I shape the kind of birth that we wanted for our baby. It was through her inspiring talks that we truly shaped our home-birth plan, as she helped guide our thinking as well as presenting many options that had not occurred to us. Thanks to her we were more than prepared for the arrival of our daughter. Not only did she provide me with the support I needed, she provided my husband with extremely helpful tools, helping him become an integral part of the birthing process.
During labour, I was so deeply thankful to have Kaurina with me as my doula. She was calming and reassuring, providing me with excellent coaching, calming my mind and body, giving me the focus and direction I needed to bring Valentina into this world as calmly and quickly as naturally possible.
After the birth of Valentina, the world came into sharp focus. No matter how many nieces, nephews, or children of friends, nothing prepared us for the intimate feeling of caring for our own child. With this also came the fears of proper care, the immediacy of her needs, and the emotional roller coaster of the post-partum period. Kaurina was there for us in every way. She answered every phone call and question, as well as coming by to check on our health, well being, and techniques; such as showing me useful breastfeeding techniques, how to care for the umbilical cord, and the best way to approach a bath for a newborn.
All of this care made for a truly beautiful birth experience, as well as ensuring a positive post-partum period; Kaurina can be thanked for it all.

Once You Go Homebirth You Never Go Back is an apt phrase that has made it’s rounds in birthing circles. It’s so true. Almost everyone who has experienced Home Birth never chooses to have their next baby in a hospital. (There are always a few exceptions for everything.)

This poem on the wonderful blog – DrMomma.org describes it so perfectly. Women’s bodies were designed to give birth. But in a hospital system, with all their protocols and policies, the natural tendencies of birthing women are hampered, and so is the indescribable power that emerges from a birthing woman who is undisturbed.

With my clients, I always get them to think about things critically. I explain the difference between evidence-based practice in medicine and non-evidence based practice. While most people would assume that ALL medical practice is evidence-based, in reality this is not practical. It is impossible for everything to be evidence based simply because new evidence is being generated on a daily basis. Sometimes research can be contradictory, or new evidence can refute old practices that have been the standard practice for decades. It is difficult for medical professionals to be always changing the way they practice to keep up with all the new research. Also, what works for some people with certain conditions may not work with other people who have variations of the condition, or compounding factors. The reason I have taken the time to explain all this is because the research on bedrest may surprise you.

The assumption is that while bedrest may be uncomfortable, inconvenient, cause muscle atrophy and make moms-to-be bored out of their minds, it is all worth it as along as it helps prevent preterm labour and reduce health problems for the baby. Any pregnant mom would be willing to do whatever it takes to have better health for her baby. I was pretty shocked, to say the least, when I examined the evidence around pregnancy bedrest, that the research doesn’t quite support the common assumption.

Surprisingly, not very much research has been done on the risks vs benefits of bedrest in pregnancy. Of the studies done, they showed that bedrest either did not improve outcomes, or it caused worse outcomes.

Research on Bedrest in Pregnancy

”Some benefits may be there, but they haven’t been documented,” said Dr. Judith A. Maloni of the Bolton School of Nursing at Case Western Reserve University, who just completed a $1.7 million study of bed rest supported by the National Institutes of Health. In fact, as Dr. Maloni’s study showed, there is good evidence that bed rest in pregnancy can cause harm, resulting in more than a dozen consequences, including babies who are smaller than normal and mothers who are too weak and tired to care for them. Their babies also tended to weigh less than normal, perhaps because there were fewer blood cells to carry oxygen and nutrients to the womb.

Dr. Robert L. Goldenberg, an expert in maternal-fetal medicine at the University of Alabama at Birmingham, said in an interview: ”Most obstetricians believe bed rest will reduce the risk of preterm births and other pregnancy complications like preeclampsia, incompetent cervix and intrauterine growth retardation. But the data are mostly nonexistent.

Dr. Goldenberg noted, for example, that in two of four clinical trials of preventive bed rest in twin pregnancies, the women randomly assigned to hospital bed rest experienced a greater rate of preterm births than those who weren’t. The other two studies showed no difference.

So why do doctors persist in prescribing bed rest, not only when prematurity threatens but often preventatively, especially in pregnancies involving two or more babies? In Dr. Goldenberg’s view, ”physicians don’t have any real tools to prevent preterm birth, but they want to do something so they choose one they think is innocuous.”

After giving birth, many of the women found themselves so out of shape that they had trouble getting out of a car or using their legs to stand up, and they were so fatigued that their ability to care for their newborns was compromised.

Dr. Maloni suggested that after childbirth, women who have been on bed rest should undergo cardiovascular and physical assessments and receive a rehabilitation program.

Physical problems aside, women who have endured enforced bed rest describe themselves as bored, frustrated, depressed, irritable, guilty and scared. Many mention increased family and spousal tensions and angry young children at home. Fathers, meanwhile, have to take over all the household responsibilities while continuing to work and wait on their wives or visit them.

The economic burdens can be great, as well, especially if the women have jobs that they can’t perform in bed and young children who need care. One study estimated the cost of bed rest per woman at $1,400.So why do so many women follow prescriptions of bed rest? Mostly because they are afraid not to. As Kris explained: ”I was told that there were no concrete studies. But fear plays a big part. You’ve got to play it conservatively. After all, it’s not just about you. It’s about one or more other beings. You have to rely a lot on the experience of your providers who believe that if a woman is put on bed rest, the pregnancy will last a little longer.”

Research indicates, that bed-rest treatment is ineffective for preventing preterm birth and fetal growth restriction, and for increasing gestational age at birth and infant birthweight. Studies of women treated with pregnancy bed-rest identify numerous side effects, including muscle atrophy, bone loss, weight loss, decreased infant birthweight in singleton gestations and gestational age at birth, and psychosocial problems. Antepartum bed-rest treatment should be discontinued until evidence of effectiveness is found.

They went on to cite evidence that exercise actually improved outcomes

Sedentary pregnant women were compared with those who participated in more than one type of leisure sports activity [22]. Active women had a significantly reduced risk of preterm birth. Women who engaged in light physical activity (walking) has a 24% reduced risk of preterm delivery and women who engaged in moderate to heavy activity (sports such as tennis, swimming or weekly running, to competitive sports several times a week) had a 66% reduced risk. The greater the intensity of the activity, the greater the reduced risk of preterm birth.

Every major organ system is rapidly affected by reduced hydrostatic gradients, and reduced loading and disuse of weight-bearing tissues during bed rest.

The American College of Obstetricians and Gynecologists has concluded that bedrest does “not appear to improve the rate of preterm birth and should not be routinely recommended.”

The bottom line is that more good scientific studies are desperately needed. In the meantime, caregivers disagree on when and how to prescribe bedrest. Some say that until there’s good evidence to the contrary, bedrest is worth a try. Others argue that bedrest itself can have a variety of negative effects and that women should not be subjected to it until we know that it does more good than harm.

These caregivers tend to believe that the use of complete bedrest should be curtailed, and that some women would be better off just taking it easy.That means restricting their activity level, cutting back on work, avoiding heavy lifting and prolonged standing, and resting for a few hours each day, for example.

If you’re going to be on prolonged bedrest, you may want to line up additional professional support. Ask your practitioner for a referral to a physical or occupational therapist, who can teach you simple exercises to do in bed to improve your circulation and maintain some muscle tone. The therapist may be able to suggest ways to reposition yourself in bed so that you’re more comfortable.

You may also benefit from counseling, since you’re likely to feel torn between your obligation to your unborn child and to your family or job. Counseling can be helpful for your partner as well if your bedrest is putting a strain on your relationship.

Why is bedrest still being recommended?

Why is bed rest still recommended despite the recent evidence that it does not prevent preterm labour? Bed rest for pregnancy problems has been a common recommendation since the early 1900’s, so it has been around a long time. If there are risks that are associated with preterm birth, most expecting mothers would expect their doctor to do be able to do something about it, and they expect bedrest to be one of those things. If a doctor went against the norm and didn’t recommend bedrest, the mom-to-be would likely find him/her to be negligent of proper care.

Furthermore, it makes logical sense that bedrest would decrease the stress put on the cervix and uterus or other systems in the body and so reduce the chance of preterm birth. It could be possible that some amount of rest, destressing and lying down could be very beneficial to high risk pregnancies.

Making sense of the situation

While it seems logical that rest and lying down may have some benefits, extreme amount of inactivity seems to be related to more problems than solutions. It is also logical that if mom’s circulation is severely compromised by long periods of inactivity, this will lead to poor circulation to baby. Also, because mom’s muscles atrophy with long periods of inactivity, she is less likely to be able to look after her newborn normally, and is less likely to have the stamina to do the hard work of labour.

In some situations where mom is doing a lot of strenuous or stressful activity in her job or daily life, having the recommendation for bedrest can be a relief. In those situations bedrest may be fantastic.

Despite the current evidence, if I were a mom who was at risk for preterm birth, I may still feel the need to avoid too much activity or be upright for long periods in the day, but at the same time, make sure I did appropriate exercises to maintain muscle strength and circulation.

This is just general information. Every mom needs to discuss her unique concerns and situation with her doctor or midwife in order to come up with a plan that she can feel comfortable with.

Resources for bedrest

Isometric Exercises

Isometric exercises focus on tightening and relaxing a muscle group, and prove helpful as a way to prepare for relaxation during labor. To carry out this type of exercise, a woman can focus on each and every muscle group beginning at her feet. Perform this exercise by clenching muscles for a brief period, such as a count of three, and then releasing them. She can squeeze a stress ball to help with hand and arm stiffness. The American Pregnancy Association also suggests simply pressing the hands and feet against the bed as a way to engage multiple muscle groups.

Core Exercises

Tightening the abdominal muscles and releasing them can help maintain some of the woman’s core strength. While sit ups and crunches may not be recommended or allowed by a doctor, a static exercise may prove sufficient. Any abdominal muscle engagement should only be done with the permission of a doctor. The health care provider may even recommend carrying these exercises out only with supervision. Static means the body remains in a position, such as reaching out from the chest at a 45 degree angle while lifting the back off the bed. Just a slight bit of resistance can help improve the abdominal strength. Squeezing and releasing the buttock muscles can help build and remain muscle tone in the core areas as well.

Back Rest

Back aches occur frequently during pregnancy. To take some of the pressure off the back, a simple arch and relax exercise can prove helpful. To do this, the woman must lie flat and slightly arch her back for a count of three. She can then rest out flat for a count of three before repeating. Lying flat for more than a few seconds is not recommended, as it can cut off the blood circulation during pregnancy. While resting or sleeping, reduce back pain by using pillows to take the weight off the muscles.

– Kegels

– Pelivc Tilts

– Back and Abdominal Strengthening

4. Here’s a video for Bedrest Exercises at a website called Educated Pregnancy with Dr Cathy. She’s got tons of other pregnancy videos on there as well.

5. And lastly, Mamas On Bedrest is a website that offers a DVD that is specific to bedrest in pregnancy. Here’s some of what the website says :

Until now there was no readily available, effective exercise program a woman could do while on bedrest. Bedrest Fitness, an exercise DVD, gives women the skills and guidance they need to safely exercise while on bedrest. Without regular exercise, a pregnant woman on bedrest is at increased risk for:

Blood clots in her legs that can lead to strokes, heart attacks or pulmonary embolisms.

“Failure to progress” during labor resulting in cesarean section delivery.

She is less able to care for herself and her new baby post partum and requires additional time to recover from her pregnancy and birth experience.

The Bedrest Fitness exercise program is designed and performed by Darline Turner-Lee, a nationally certified physician assistant, an American College of Sports Medicine Exercise Specialist® and certified perinatal fitness instructor. The exercise DVD takes women through a series of gentle yet effective movements and also offers a brief lecture on bedrest. Women who regularly perform the exercises while on bedrest can expect the following health benefits:

Maintenance of muscle tone and physical strength

Improved circulation

Reduction in the risk of leg clots leading to strokes, heart attacks and pulmonary embolisms

Increased endurance during labor

More effective pushes during delivery

Decreased recovery time post partum

The emotional assurance that she is doing something great for herself and her baby

The exercise program adheres to the guidelines set forth by the American College of Obstetricians and Gynecologists for exercise during pregnancy and uses pillows for support and rubber exercise bands for resistance. A rubber resistance band comes with the exercise DVD.

So I hope you have found this information useful. I hope you realise that you don’t have to feel like the situation is out of your control if bedrest has been recommended. Complete bedrest for weeks at a time is not as useful as was previously thought, so a balanced approach seems to be more beneficial. You still have a lot of choices that you can make, and figure out how to balance resting and destressing with strategic activities for muscle strength and circulation, and still live life as normally as possible.

Have fun, and let me know about your experience in the comments below!

Anyone who knows me, knows that I’ve been working on writing a book about birth for a couple of years now. Anyone who’s ever written a book, knows that writing a book is a tricky process.

For me, the trickiest bit has been deciding on the angle to write it from. I know what specific topics I’m passionate about. I’m just trying to figure out how all the theses I have evolved over the years can fit together like nice a big puzzle. And how it’s going to have themost impact on improving the culture of birth in the world.

So far I have come up with an outline I’m pretty proud of. Here goes :

The Epistemology of Woman-Centred Maternity Care :

Bridging The Gap Between Natural and Medical Models of Birth

In the book I would like to offer solutions to a problem as I see it. While so many advancements have been made in the field of maternity care, and we now know more than ever before, the outline of the problem is this :

1.The statistical rates of mortality, morbidity and complications are still higher than they need to be in much of the world, as evidenced by considerably lower rates in a few places in the world. While poverty is a factor that contributes to much of those statistics, and is a factor that is beyond the scope of this book to address, there are other easier to address factors besides poverty that can be reduced, and I shall highlight some of them. The natural process of birth and medical management of birth exists in a delicate balance. Many experts point to evidence that overuse of medical intervention in birth has tipped the scales of safety towards less safe outcomes. While benefiting those who need it, it has been suggested that its over reliance and use on those who don’t need it has in fact, CAUSED some complications and poor outcomes for mothers and babies.

2.Beyond the statistics, are many women and children who are physically and emotionally damaged in small and large ways by the management of their births.

3. In an effort to avoid this overuse of medical techniques in birth, a small but growing percentage of the population of North America has turned instead to avoiding the hospital altogether as they do not feel safe giving birth there. There is also an alternative philosophy to the medical management model, which is woman-centred care. The field of midwifery is generally responsible for the knowledge produced on woman-centred maternity care, although many individual doctors practice this way, and not all midwives practice woman-centred care. Woman-centred care is the topic I would like to delve more deeply into in this book so that everyone can get a clearer picture of what that means, what it entails in real life practice and how it can make significant differences in outcomes as well as people’s real lives. So while there is a body of knowledge that comes out of the experience of midwives and the experience of homebirth, there is a tremendous gap between that body of knowledge and mainstream medical maternity care.

4. Furthermore, the body of knowledge that is still missing from both these perspectives of midwives and medical professionals is the epistemology that can come from the experience of the women doing the birthing themselves. I would like to suggest that by piecing together the knowledge from individual women’s experiences and formulating a collective position, it would be possible to bring maternity care a a whole new standard, as well as bridge the gap between the medical and natural birth worlds.

Everything in our world is always improving and evolving. There is no reason why the culture of human birth should not. I strongly believe, however, that the improvements will not come from more technology, but from a deeper understanding into the human psyche of labouring women themselves. It is the inner mental and emotional experience of labour that can offer the clues to understanding the delicate hormonal balance that controls the normal process of birth. While medical advancements have made it safer than ever before to use medical interventions such as epidurals and cesareans in birth, they will probably always be less safe than the non-man-made process of birth. Just as infant formula can be made as close as possible to breastmilk, it will always remain a far cry because it is impossible to create the living enzymes, antibodies and ever changing micronutrients in breastmilk. The long term effects of medical interventions into the process of birth is far greater than anyone can comprehend. I would like to suggest, despite all our advancements and 100,000 years of human history, shockingly little is understood about the normal, uninterrupted process by which human beings come into the world. I would like to bring more understanding of this into mainstream knowing. It is my hope that by fitting the missing pieces together, we can have a future world where human beings start off their lives with less trauma and more love because it is this that makes us human.

I’m putting it out there for anyone reading this : If you would like to add your contribution to the book, please let me know. You can email me at kaurina at prenataljourney.ca or call 1 – 604 809 3288.

I am looking for : childbirth experts – midwives, doctors, nurses and doulas, as well as, moms who would like to add their own experiences.

I know your time is valuable, so I would make it as easier as possible for you to add your input. If you prefer to writing, you can write me an email on the aspect you would like to contribute. If you would like to do an interview instead, I can set up a convenient time for you to do an interview.

Needing to schedule an Induction or Cesarean for medical reasons?

This info might help you and your baby …

Different doctors and midwives have different dates they think are appropriate for scheduling a planned cesarean or induction – usually around 38 or 39 weeks in pregnancy. Most people have been told that babies have done most of their development by about 37 weeks, so inducing or scheduling a cesarean at 38 weeks is no big deal. The reality tells a different story.

The number of babies admitted to neonatal nurseries for problems of prematurity has been steadily increasing along with the increasing rates of inductions and cesareans done before labour can start on its own. Babies induced or cut out at 38 weeks are more likely to have problems than babies induced or cut out at 39 weeks. If planning a cesarean for medical reasons, it`s even better to wait til labour starts naturally on its own and then do the cesarean because then you can be totally sure that it is ready to be born. Of course, that may not fit neatly into obstetricians schedules, so you may have to be a bit more determined to make that happen if that`s what you decide.

In the natural process of birth, labour starts on its own when both mother and baby are ready. Normally, baby will send mom hormone signals when all the systems in the baby are fully developed for life outside the womb – eyes, lungs, brain, liver etc. and it is ready to be born. When mom is feeling ready for birth, her body will also produce hormones that can trigger the start of labour. So both of these hormones need to be present for labour to begin – mom`s and baby`s.

We all know about problems of severe prematurity, but what this article is about is called Late Preterm. That means that baby is past 37 weeks gestation, but it is not yet fully ready to be born. It may have a higher chance of having respiratory problems at birth, asthma later in childhood, eyesight problems in childhood, smaller brain size, lower birth weight, increased risk of severe jaundice (when the liver cannot cope with processing the blood), and breastfeeding difficulties.

Because doctors have believed that inducing or scheduling cesareans at 38 weeks was safe, the rates have skyrocketed. But a new study has confirmed what many believed – that 39 weeks is safer. Read Ohio Hospital moves induction dates to 39 weeks. The study shows how changing hospital the hospital policy of a safe date for inductions or planned cesareans to 39 instead of 38 weeks prevented approximately 500 admissions to neonatal intensive care units and 34 infant deaths. In addition, this project has saved approximately $27 million in health care costs through avoided NICU (neonatal intensive care unit) admissions.

Of course, the safest option is to wait for labour to start on it`s own, but there may be some medical situations where waiting may pose risks as well, for example high blood pressure, pre-eclampsia, Cholestatis etc. In these situations, to make a decision, you have to weigh the risks and benefits of each option. What are the risks of waiting compared to the risks of early induction. high blood pressure, for example, may not carry as serious risks as pre-eclampsia, and so you may want to wait longer if an induction is recommended, preferable past 39 weeks. You can still get regular fetal monitoring done to make sure baby is still doing fine.

Tips to help you make an informed decision

If your doctor or midwife is suggesting scheduling an induction or a cesarean, you can ask these questions :

1. Is this really necessary?

Now that you know the risks of causing your baby to be born before it is ready, is it worth it? Do you really have a serious problem that can justify the risks of induction or cesarean? You would be surprised how many are done for non-serious issues eg. past 40 weeks, mom is 40 years old and so is considered old, mum has borderline high blood pressure, suspected gestational diabetes and many more reasons. These may not be serious issues. Have a discussion with your care provider and find out more information.

2. If you have determined it is necessary, can it be delayed as long as possible, with regular monitoring of baby`s heart rate to make sure it is still doing well?

3. If planning a cesarean, is your doctor willing to wait till your labour naturally starts on its own? If not, are you willing to change doctors?

4. If that is not possible, State that you would like the procedure to be done past 39 weeks instead of 38 weeks.

This information may very well save you and your baby a lot of unnecessary stress and problems. I hope you have found this useful. If you have any questions or comments, please leave them in the box below, or contact me at 604 809 3288.